Relationships between a Dissociative Subtype of PTSD and Clinical Characteristics in Patients with Substance Use Disorders

The increasing support for a dissociative subtype of post-traumatic stress disorder (PTSD-D) has led to its inclusion in DSM-5. We examined relationships between PTSD-D and relevant variables in patients with substance use disorders (SUD). The sample comprised N = 459 patients with SUD. The International Diagnostic Checklist and the Posttraumatic Diagnostic Scale were used to diagnose PTSD. In addition, participants completed the Childhood Trauma Questionnaire and the Dissociative Experiences Scale. The course of SUD was assessed by means of the European Addiction Severity Index. One-fourth of participants fulfilled a diagnosis of PTSD (25.3%). Patients with PTSD-D (N = 32, 27.6% of all patients with PTSD) reported significantly more current depressive symptoms, more current suicidal thoughts, more lifetime anxiety/tension, and more suicide attempts. The PTSD-D group also showed a significantly higher need for treatment due to drug problems, higher current use of opiates/analgesics, and a higher number of lifetime drug overdoses. In a regression model, symptoms of depression in the last month and lifetime suicide attempts significantly predicted PTSD-D. These findings suggest that PTSD-D is related to additional psychopathology and to a more severe course of substance-related problems in patients with SUD, indicating that this group also has additional treatment needs.     

The Surgeon General's Facing Addiction report: An historic document for health care

ABSTRACT

The publication of Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health presents an historic moment not only for the field of addiction medicine, but also for the United States as a nation. The Board of Directors of the Association for Medical Education and Research in Substance Abuse (AMERSA), on behalf of our organization, would like to express our appreciation of the efforts of Dr. Vivek Murthy and the Surgeon General's Office to publish the first surgeon general's report covering substance misuse and substance use disorders.     

A preliminary study of subclinical panic symptom elevations among adolescent offspring of parents with PTSD who smoke

Objectives: Research has linked parental post-traumatic stress disorder (PTSD) and parental smoking to a wide array of psychological and physical health concerns among offspring. Furthermore, the combination of parental anxiety psychopathology generally, along with smoking, has been linked to elevated adolescent panic symptomatology. However, no research has examined the unique and interactive associations between parental PTSD and smoking in terms of offspring panic. Method: The current study sought to begin to address this gap in the literature by examining adolescent-reported panic symptom levels as a function of parent-reported PTSD and current smoking. Results: Among 25 dyads (M_{parent age}?=?42.92 years [SD?=?6.71]; M_{offspring age}?=?15.80 years [SD?=?1.04]), adolescent offspring of smokers with PTSD reported significantly higher panic symptoms compared with all other combinations of these factors after controlling for multiple theoretically relevant and empirically associated covariates. Supporting model specificity, parental PTSD and smoking were not related to adolescent depression or other types of anxiety. Conclusions: These results are consistent with research linking the combination of parental anxiety psychopathology and smoking to offspring panic generally, and parental PTSD and smoking to panic symptoms specifically. Research on possible mechanisms of intergenerational transmission as well as replication and extension of these findings is now needed.     

Untreated Symptoms of PTSD Among Cocaine-Dependent Individuals: Changes Over Time

Changes over time in posttraumatic stress disorder (PTSD) symptoms during periods when individuals with substance use disorders remain abstinent has not received much attention. PTSD symptomatology over a 36-month period was studied in cocaine-dependent individuals (N = 34) who entered a pharmacologic trial targeting cocaine use and depression, but did not include any treatment for PTSD. All participants reported at least one PTSD Criterion A event, and 17.6% had current PTSD at baseline (Base PTSD+). Significant improvements in PTSD symptoms were observed on global measures of PTSD, but not on the Impact of Events Intrusion subscale. Significant improvement in drug use severity also was observed. Compared with participants who were negative for PTSD at baseline, Base PTSD+ participants were significantly more likely to: (a) meet criteria for current PTSD at follow-up and (b) have been re-victimized over the time period of the study. Careful evaluation of intrusive symptoms may be particularly important when diagnosing PTSD in individuals with SUDs, and repeated assessment of traumatic experiences may be necessary in longitudinal studies.     

Substance Use and Abuse for Youths in Foster Care: Results From the Communities That Care Normative Database

This study uses the Communities That Care Normative database to examine the prevalence of drug and alcohol use and abuse among foster care youths in comparison to youths not living in a foster home setting. The foster youths were more likely to have used all of the examined illicit substances, and these differences generally remained after controlling for a number of demographic differences between the two groups. These negative differences appear to be amplified for females in foster care. The overall high-risk profile of foster youths makes them an especially important population for targeted prevention.     

Internet Game Addiction,Parental Attachment,and Parenting of Adolescents in South Korea

The adolescent-parent relationship is a major factor influencing juvenile delinquency, and Internet gaming addiction may exacerbate any conflict in that relationship. The aim of this study was to determine the relationships among Internet game addiction, parental attachment, and parental attitude toward the rearing of adolescents in South Korea. The initial selected convenience sample comprised 624 middle school and high school students. Self-reported measures of an Internet Game Addiction Scale, Inventory of Parent and Peer Attachment–Revised version, and the modified Parental Acceptance-Rejection Questionnaire were analyzed. A significant relationship was found between Internet game addiction and both parental attachment and the adolescents’ perception of parenting of adolescents. Those helping adolescents with an Internet game addiction should consider not only the adolescents’ Internet game usage pattern but also their relationship with their parents.     

Repeated Addiction Treatment use in Sweden: A National Register Database Study

Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. Implications: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.     

Evidence for Site-Specific,Systematic Adaptation of Substance Prevention Curriculum With High-Risk Youths in Community and Alternative School Settings

The problem of substance use among older youths is often disregarded in prevention research. The prevailing perception has been that prevention programming is developmentally inappropriate for those who are actively experimenting with substances. This project examines the differential effectiveness of youth-driven adaptations of the evidence-based prevention program, keepin' it REAL (kiR). During Phase I, high-risk youths in a variety of community settings (social, therapeutic, and academic) tailored kiR workbooks/videos to increase the relevance for their peers, older adolescents who are likely to have already initiated drug use. Phase II, discussed here in detail, evaluates the effectiveness of the adapted versions of kiR compared with the original and comparison condition using a quasi-experimental pretest-posttest design with a 6-week follow-up and focus groups. Data suggest that participants receiving the adapted version of the curriculum experienced greater improvement in acceptance and use of substances than youths in the other two groups.     

Resting Heart Rate Variability: Exploring Associations With Symptom Severity in Adults With Substance Use Disorders and Posttraumatic Stress

Objective: Substance use disorders and posttraumatic stress symptoms are commonly comorbid. Previous studies have established that those with substance use disorders or posttraumatic stress disorder (PTSD) have lower high frequency-heart rate variability (HF-HRV) compared to controls, suggesting that low HF-HRV may be a biomarker of a common physiological mechanism underlying both disorders. We evaluated HF-HRV as a potential biomarker of a common underlying process by testing whether lower HF-HRV related to greater severity of substance use and PTSD symptoms in individuals with both substance use disorders and at least four symptoms of PTSD. Methods: HF-HRV was measured in 49 adults with substance use disorders and at least four symptoms of PTSD. We performed a series of regressions controlling for age to test whether low HF-HRV was associated with greater substance use disorder and PTSD symptom severity. Substance use disorder symptoms were measured by the Addiction Severity Index and PTSD symptoms were measured by the Clinician-Administered PTSD Scale and the PTSD Checklist. Results: After controlling for age, low resting HF-HRV was significantly associated with drug and alcohol symptom severity but not PTSD symptom severity. Conclusions: HF-HRV may be more sensitive to the severity of drug and alcohol use rather than PTSD. Findings may suggest that in PTSD populations, HF-HRV may primarily index comorbid substance use disorder symptoms. HF-HRV could serve as an objective measure of substance use severity and should be further investigated as a predictor of outcomes in treatment for substance use disorders.     

Social Influence on Adolescent Polysubstance Use: The Escalation to Opioid Use

Background: Fewer than 9% of 12–17 year olds in need (～146,000 of 1.7 million) receive inpatient or outpatient substance abuse recovery services or other mental health services (SAMHSA, 2012). The literature on adolescent addiction is sparse, however, as most published addiction recovery efforts involve adult populations—often college students. Objectives: The present study examined social influences on escalating substance use (from tobacco, alcohol, and marijuana use to polysubstance use involving opioids) for students enrolled in recovery high schools. Methods: A sample of 31 adolescents enrolled in substance use recovery high schools were surveyed on their patterns of substance use leading to their abuse of opioids. Results: Youth who begin their substance use as young as age 8 are often pressured by peer culture to do so and come from substance-using families. Their escalation in polysubstance use to a pattern including opioids was also most often attributed to peer influence over several years. Conclusions/Importance: This paper is one of scant few that address patterns of use in high school students. Perhaps most salient from this study are the tertiary prevention implications: similar to their adult counterparts, students enrolled in recovery high school programs are likely from substance-using families and have combined complex constellations of substances including opioids by dint of their relationships with substance-using peers.     

Characteristics of a Treatment-Seeking Population in Outpatient Addiction Treatment Centers in Mexico

Background: Baseline patients’ characteristics are critical for treatment planning, as these can be moderators of treatment effects. In Mexico, information on treatment seekers with substance use disorders is scarce and limited to demographic characteristics. Objective: This paper presents and analyses demographic characteristics, substance use related problems, clinical features, and addiction severity in a sample of treatment seekers from the first multi-site randomized clinical trial implemented in the Mexican Clinical Trials Network on Addiction and Mental Health. Methods: A total of 120 participants were assessed prior randomization. Chi square or F-tests were used to compare sites across variables. Spearman correlation was used to associate negative consequences of substance use and motivation to change. Results: The majority of participants were men, and the most prevalent substances reported were alcohol, marijuana, and cocaine. Participants were predominantly on the contemplation or action stage of change, and this was correlated with the perception of the negative consequences associated with substance use. Participants reported a high prevalence of substance use related problems. Conclusions: Substance use related problems, clinical features, and addiction severity reported by treatment seekers are important characteristics to take into account when planning treatment as they facilitate tailoring treatment to meet patients’ needs.     

Medicine Resident Preparedness to Diagnose and Treat Substance Use Disorders: Impact of an Enhanced Curriculum

Background: The authors’ previous study found that despite caring for many patients with addiction, most Massachusetts General Hospital (MGH) internal medicine residents feel unprepared to treat substance use disorders (SUDs) and rate SUD instruction during training as fair or poor. This follow-up study evaluates the impact of an enhanced curriculum on resident perceptions of the quality of instruction, knowledge base, and self-perceived preparedness to diagnose and treat SUDs. Methods: Based on the findings of the earlier study, an enhanced SUD curriculum was designed and delivered to MGH medicine residents. Impact of the curriculum was evaluated using the same Web-based survey that was administered in the earlier study to compare pre- and posttest results. Results: The authors’ earlier study found that 75% of residents felt prepared to diagnose and 37% to treat SUDs and 45% of residents rated the overall quality of SUD instruction as good or excellent. Following the curriculum intervention, 87% of residents reported feeling prepared to diagnose (P = .028) and 60% to treat (P = .002) SUDs. Three quarters of residents rated the overall quality of instruction as good or excellent (P < .001), and 98% reported residency curriculum had a positive impact on their preparedness to care for patients with a SUDs. Residents who reported receiving an adequate amount of SUD instruction were more likely to feel prepared to diagnose and treat addiction (P < .001). Thirty-one percent of residents still rated the overall amount of SUD instruction as too little. The intervention did not significantly improve answers to knowledge questions. Conclusions: An enhanced SUDs curriculum for medicine residents increased self-perceived preparedness to diagnose and treat SUDs and educational quality ratings. However, there was no significant change in knowledge. Implementation of a more comprehensive curriculum and evaluation at other sites are necessary to determine the ideal SUD training model.     

A recent history of opioid use in the US: Three decades of change

Background: The opioid epidemic in the United States is a problem that has developed over decades. While clinical, regulatory, and legislative changes have been implemented to combat this issue, changes will not be immediate. Moreover, the changes that have been carried out may have unintended negative consequences such as increased use of illicit opioids (e.g., heroin and synthetics) and challenges in effective and appropriate pain management.

Objectives: This review focuses on the last three decades and presents key changes the United States has seen in the use of opioids. Conclusions/Importance: There have been numerous policy changes and programs aimed at decreasing opioid use and abuse in the United States; however, it will take a major shift in the mindset of clinicians, the general public, and policy makers to alleviate this epidemic.     

PTSD in the COVID-19 Era

Background In December 2019, Wuhan City in Hubei Province, China witnessed an outbreak of a novel type of coronavirus (COVID-19), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The sharp rise in the number of infected cases and the surge spike in fatalities worldwide prompted the World Health Organization (WHO) to declare this rapid outbreak a global pandemic in March 2020. The economic, health, and social ramifications of COVID-19 induced fear and anxiety all over the world.Objective The purpose of this review is to discuss how precautionary measures and restrictions imposed by governments, such as quarantines, lockdowns, and social distancing, have not only caused economic losses, but also a rise in mental health problems specifically post-traumatic stress disorder (PTSD).Methods A deep comprehensive review of the relevant literature regarding the pandemic and its debilitating consequences on the psychological status of the public was performed.Results This review illustrates that the pandemic had a traumatic impact on the psychological functioning of the public, particularly COVID-19 survivors, older adults, and healthcare workers, due to difficulties in coping with new realities and uncertainties.Conclusion In this review, we have discussed the psychological implications of this pandemic and we have provided an extensive background for understanding options regarding PTSD management in healthy individuals and those with preexisting conditions.     

Attributions of Responsibility for Addiction: The Effects of Gender and Type of Substance

In 1997, 248 urban university students in central Massachusetts rated responsibility for addiction using the Attributions of Responsibility for Addiction Scale (ARAS), developed for this study with university-based financial support. The vignette-based factorial design varied sex of drug user and type of addictive substance. Factor analysis yielded two subscales: internal and external responsibility attributions; the dependent variable was the internal-to-external attribution ratio. Analysis of variance indicated main effects for substance type and drug abuse experience and showed interaction effects for participant's sex by user's sex and user's sex by substance type. Authors discuss implications, study limitations, and future research.     

Alcoholism treatment of Vietnam veterans with post-traumatic stress disorder

Vietnam veterans with alcoholism and Post-Traumatic Stress Disorder (PTSD) are a clinically problematic population. Early self-medication of the PTSD with alcohol led for some to alcohol abuse and dependency. These may often be treated in an intensive alcoholism program. At evaluation both diagnoses are made, and patients are told that alcohol or drug use is not tolerated. The program first focuses on traditional alcoholism treatment issues. Early and consistent support to enhance self-esteem and to reduce guilt helps the patient later to tolerate the gradual investigation of the anger and self-loathing associated with both disorders. Important forces include family and peer support, effective limit setting in a structured milieu, supportive confrontation of alcoholic denial through multidisciplinary treatment in the absence of alcohol. Outpatient follow-up treatment groups include other PTSD sufferers and focus on establishing trust, interweaving the issues of adjustment to sobriety with discussion of the combat experience in a safe, accepting environment, with careful modulation of anxiety by the clinician. Medication must be conservative; benzodiazepines are not used after the detoxification period.     

Mindfulness-Based Interventions: An Antidote to Suffering in the Context of Substance Use,Misuse, and Addiction

The cultivation of mindfulness as an approach to human perception through the practice of meditation has become an increasingly popular treatment for medical and psychological symptoms and as a topic of scientific investigation. Substance user programs are also increasingly embracing this treatment strategy as either a stand-alone therapeutic modality or a complement to ongoing treatment. In this article, I supply an introduction to the special theme issue concerning mindfulness and substance use intervention by first providing a brief historical account of the secular Mindfulness-Based Stress Reduction program to introduce new readers to the more general topic of mindfulness-based interventions (MBIs), and to contextualize historical publishing trends observed in mindfulness research across the past four decades. I then examine the implications of MBIs for substance use, misuse, and addiction, especially in areas related to craving and suffering. To conclude, I outline the empirical and conceptual compendium of contributions offered in this special issue.